单阴囊切口且不结扎鞘状突在可触及型隐睾治疗中的应用研究

目的:通过对可触及型隐睾采用单阴囊切口且离断不结扎鞘状突行睾丸下降固定的手术方法的应用,探讨此方法的可行性及近期效果观察。方法:通过一项回顾性研究,纳入从2015年1~12月间因隐睾入院手术的病例:可触及型隐睾109例(125侧)(A+B组);未触及型隐睾15例(C组)。前者采用单阴囊切口+近内环口高位离断鞘状突(未结扎)睾丸下降固定(A组,53例,61侧)或标准腹股沟阴囊双切口睾丸下降固定(B组,56例,64侧),后者腹腔镜探查(C组)。分析单阴囊切口睾丸固定术在可触及型隐睾中的治疗成功率、术后近远期并发症、斜疝或鞘膜积液的发生(复发),以及单、双切口(A、B组)治疗可触及型隐睾中相关参数的比较。结果:可触及型隐睾患儿中位年龄1.4(0.6~11.0)岁。A组:中位年龄1.5(0.6~7.0)岁。隐睾侧别:左24例,2例伴有鞘膜积液;右20例,1例伴有鞘膜积液,2例术中增加腹股沟切口;双侧9例,1例右侧术中增加腹股沟切口。治疗成功率为95.1%(58/61)。B组:中位年龄1.4(0.8~11)岁。隐睾侧别:左27例;右22例,3例伴有腹股沟斜疝;双侧7例,1例术后右侧睾丸回缩。两组中鞘状突未闭合率80.8%(101/125)。未触及型隐睾C组15例全部腹腔镜探查:2例睾丸先天缺如;6例睾丸发育不良且切除;3例在内环口呈"窥视",改普通双切口术;4例腹腔镜手术固定。切口愈合良好,无睾丸萎缩,无斜疝或鞘膜积液发生(复发)。结论:单阴囊切口且不结扎鞘状突治疗可触及型隐睾是一种安全的手术方法,且不结扎鞘状突未增加发生斜疝或鞘膜积液的风险。     

腹腔镜整体分离鞘状突和精索在小儿腹股沟型隐睾手术中的应用

目的探讨腹腔镜整体分离鞘状突和精索在小儿腹股沟型隐睾手术中的应用价值。方法回顾性分析2008年2月至2014年2月,广东省佛山市第一人民医院施行小儿腹股沟型隐睾腹腔镜手术95例患儿临床资料,将其中应用腹腔镜整体分离鞘状突和精索实现隐睾松解的患儿与其他不同手术方式的患儿进行比较,对比手术时间、手术出血量,以及术中损伤和术后并发症的发生率。结果腹腔镜手术治疗小儿腹股沟型隐睾共95例、125侧,按鞘状突开闭状态和睾丸位置的不同进行分型并实施不同手术方式:鞘状突闭合低位睾丸型8例、12侧(A组),腹腔镜探查后转阴囊切口松解固定隐睾;鞘状突闭合高位睾丸型6例、7侧(B组),腹腔镜下经腹膜后松解精索血管及隐睾;鞘状突未闭低位睾丸型8例、11侧(C组),腹腔镜内环口结扎后转阴囊切口松解固定隐睾;鞘状突未闭高位睾丸型73例、95侧(D组),应用腹腔镜下整体分离鞘状突和精索实现隐睾松解固定。各组手术时间、手术出血量差异无统计学意义;各组均无术中副损伤;术后并发症发生率:A组0%,B组42.9%,C组9.1%,D组4.2%。结论对于鞘状突未闭的腹股沟型隐睾,整体分离鞘状突和精索的方法松解隐睾能避免精索血管和输精管损伤;对于鞘状突闭合的腹股沟型隐睾,因无鞘状突腹膜引导松解精索,术后缺血性并发症发生率较高,不推荐在腹腔镜下松解。     

隐睾患者睾丸附睾畸形的临床观察

1 临床资料 1991年以来,我们诊治隐睾患者睾丸附睾畸形60例,年龄2～18(平均8)岁,单侧隐睾56例,其中右侧30例,左侧26例,双侧隐睾4例。外环型21例,腹股沟管型39例。均为术中证实,60例隐睾患者睾丸均有不同程度变小变软,睾丸附睾连接处畸形58例(96.7％),可分为3类;①附睾头部与睾丸分离48例(80％),包括附睾头部与睾丸完全分离和部分分离;②附睾体部与睾丸分离3例(5％);③附睾头体与睾丸分离7例(11.7％)。     

腹腔镜下切除不可触及隐睾残迹的病理分析

目的探讨腹腔镜下切除不可触及型隐睾患儿睾丸残迹的必要性。方法回顾性分析2015年1月至2018年12月共16例隐睾患儿,月龄11～98月,平均(36.0±25.4)个月,均为单侧,左侧12例(75%),右侧4例(25%),术前彩超提示阴囊、腹股沟区、腹腔内至肾门未见睾丸样物,通过腹腔镜检查,14例(85.7%)鞘突管已闭合,输精管和精索发育差,已进入腹股沟区。通过腔镜下游离,将输精管末端牵回腹腔内切除,切除末端送病理检测。结果病理提示,8例(50%)送检组织为横纹肌、纤维血管脂肪组织,未见睾丸组织;3例(18.75%)为附睾及输精管组织;1例(6.25%)送检物为纤维脂肪组织中仅见2个腺管;符合左侧发育不良睾丸组织2例(12.5%);另外2例(12.5%)患儿输精管和精索末端于腹腔内发育中断,未进一步处理。结论腹腔镜下腹股沟管内环已闭合,输精管和精索已进入腹股沟管内,不可触及型隐睾病理结果未见恶变肿瘤组织,是否行隐睾残迹常规切除需结合多方面因素决定。     

显微镜下输精管交叉端侧吻合治疗无精子症1例报告

正无精子症作为引起男性不育症中常见的原因,目前外科处理方法分别以睾丸前、睾丸、睾丸后3种因素划分。睾丸前因素主要针对垂体及甲状腺等引起的病变,睾丸因素以精索静脉曲张及隐睾等病变为主,而睾丸后因素以输精管及附睾梗阻最为常见。现对我院1例双侧附睾梗阻合并先天性右侧输精管发育异常引起的无精子症,行显微镜下输精管交叉端侧吻合术结果报告如下。1资料与方法1. 1临床资料患者,男,30岁,婚后6年夫妇规     

阴囊及直肠腔内彩色多普勒超声在无精子症诊断分型中的价值

目的分别应用经阴囊及直肠腔内彩色多普勒超声进行无精子症的精确诊断分型,探讨两者在分型中的价值。方法收集2010年1月至2013年6月于中山大学附属第三医院就诊且临床初步诊断为无精子症的男性不育症患者496例,所有患者均行经阴囊及经直肠腔内彩色多普勒超声检查。根据文献资料及临床特点,我们提出无精子症的6种分型:Ⅰ型,超声检查均未见异常;Ⅱ型,睾丸源性病变引起的非梗阻性无精子症;Ⅲ型,输精管道先天畸形所致梗阻性无精子症;Ⅳ型,其他病变可疑与梗阻性无精子症相关;Ⅴ型,混合型,同时存在非梗阻及梗阻原因;Ⅵ型,精索静脉曲张。结果Ⅰ型,19例;Ⅱ型,睾丸体积<10 ml,63例;Ⅲ型,235例,其中附睾缺如30例,输精管缺如76例,精囊缺如59例,精囊萎小或发育不良20例,输精管缺如并精囊缺如38例,附睾、输精管及精囊均缺如12例;Ⅳ型,87例,其中附睾头囊肿16例,精囊囊肿5例,前列腺中部囊肿41例,附睾炎7例,输精管钙化5例,精囊钙化13例;Ⅴ型,6例;Ⅵ型,86例。结论结合经阴囊高频及经直肠腔内彩色多普勒超声行无精子症的精确诊断分型,其中Ⅱ型、Ⅲ型及Ⅵ型超声能相对明确诊断。     

睾丸横过异位合并输精管Y型融合1例报告

正睾丸异位(ectopia of testis)是隐睾疾病中的一类,发病率占隐睾的5%,而隐睾发病率仅为1%[1]。睾丸横过异位(transverse testicular ectopia, TTE)是睾丸异位中的一种特殊类型,为双侧睾丸穿过同一腹股沟管下移到腹股沟管内或阴囊,较为罕见,而睾丸横过异位合并输精管融合更加罕见[2]。2018年10月我院收治睾丸横过异位合并输精管Y型融合1例,报告如下:1 病例资料患儿,男,4岁,     

精索阻滞用于阴囊内手术143例报道

自1986年4月至1990年10月,我们用精索阻滞用于阴囊内手术143例,年龄18～68岁,其中输精管结扎术63例,睾丸活检35例,睾丸及附睾脓肿引流术13例,睾丸鞘膜积液翻转术10例,输精管吻合术9例,附睾切除术8例,精液肉芽肿切除术3例,输精管附睾吻合术2例。术前1h给病人肌注吗啡10mg、654-210mg。阻滞的方法是首先找到精索从外     

腹股沟可触及睾丸的小儿隐睾的腹腔镜治疗体会

目的探讨腹腔镜技术在小儿腹股沟可触及隐睾中的应用。方法对23例26侧腹股沟可触及睾丸的隐睾患儿进行腹腔镜睾丸下降固定术治疗。其中左侧隐睾8例,右侧隐睾12例,双侧隐睾3例。结果 23例中有20例隐睾患者经腹腔镜手术均能分离到足够长度的精索及输精管,使睾丸能通过腹股沟管顺利降至阴囊中而I期完成手术。术后随访6月睾丸发育良好,睾丸无回缩,均未出现睾丸萎缩、腹股沟斜疝及鞘膜积液等并发症。3例转为腹股沟开放性手术。结论腹腔镜治疗腹股沟可触及的隐睾方法可行,疗效满意。     

隐睾儿童血清表皮生长因子及其受体表达的临床意义

我们采用放射免疫分析 (RIA)和免疫组织化学方法检测 88例隐睾患儿手术前后血清表皮生长因子 (EGF)浓度和睾丸组织EGF受体 (EGFR)的表达情况 ,探讨EGF在儿童隐睾症中的作用及机理。现报告如下。材料与方法　隐睾患儿 88例 ,年龄2～ 14岁 ,平均 7.1岁。按隐睾位置高低分为外环型 (低位型 ) 2 0例、腹股沟型(中位型 ) 5 1例和腹内型 (高位型 ) 17例 ;按侧别分为单侧型 2 0例 ,双侧型 6 8例。按就诊年龄分为 3组 :2岁～组 2 4例 ,5岁～组 35例 ,>10岁组 2 9例。行睾丸固定术后 6个月患儿 2 6例 ,平均年龄6 .8岁。正常儿童组为随机选取的…     

Malformations of the epididymis in undescended testis

Epididymal abnormalities in undescended testes are probably more common than suggested in the literature but only sporadic reports are found on this subject. For many years discussions have centered around the ideal age to operate on patients with undescended testes and consequently increase chances for future fertility. We analyzed 66 patients (82 testes) treated for undescended testis in our department, with special distinction between ectopia and cryptorchidism. Abnormalities ranged from simple epididymal elongation to more complex forms, such as complete disruption between the testis and epididymis. Among 49 ectopic testes the epididymides of 19 (38.8%) displayed more severe abnormalities in addition to elongation, while 16 (32.6%) showed only an elongated epididymis and 14 (28.6%) were normal. Among the 33 cryptorchid testes 29 (87.9%) showed the more complex anomalies and elongation, 3 (9.1%) were normal and only 1 (3%) was elongated. Our results demonstrate a much higher incidence of complex epididymal abnormalities in cryptorchidism (p less than 0.001). Elongated epididymis may present problems for sperm maturation and transportation, although with no other associated abnormality most can be regarded as patent. In our theory cases of elongation plus other major abnormalities probably are associated with severe impairment in sperm maturation and hindered transportation, with the future intrascrotal or extrascrotal position of the testis or early surgical repair being of little importance in terms of fertility.     

Does orchidopexy revert the histological alterations in epididymal and vas deferens caused by cryptorchidism?

Cryptorchidism is a pathological condition in which the testicles are retained in the abdominal cavity, resulting in atrophic seminiferous tubules. Some gross structural abnormalities and histological altercations have been described in the epididymis and vas deferens in humans with cryptorchidic testes. Orchidopexy surgery restores testicular spermatogenesis in experimental and clinical procedures, but it is still unclear whether histological changes in the epididymis and vas deferens caused by cryptorchidism may be reverted by orchidopexy. The aim of this study was to evaluated the histological changes in the epididymis and vas deferens following experimental uni- bilateral cryptorchidism in mature and immature mice, and to determine whether altercations could be reversed by orchidopexy. Young and adult C57 BL6 mice were randomized into three groups: control mice, bi/unilaterally cryptorchidic mice and bilaterally cryptorchidic mice with orchidopexy. After evaluation of testis, epididymis and vas deferens, there were no histological alterations in contralateral epididymis of mice unilaterally cryptorchidic. Ipsilateral epididymis of unilaterally cryptorchidic mice and epididymis from bilaterally cryptorchidic mice showed significant histological alterations. Orchuidopexy resorted normal spermatogenesis and the histological features of epididymis. It would appear that persistent male infertility clinically observed after orchidopexy could not be related to histological alteration in the testis and epididymis. Development and maintenance of the vas deferens seems to be controlled independently of the epididymis since it was not altered by cryptorchidism condition.     

Postpubertal testicular/epididymal epithelial thickness alterations in unilateral epididymal/vasal obstruction of prepubertal rats

This study was conducted to evaluate postpubertal testicular and epididymal epithelial changes induced by unilateral epididymal and vasal obstruction in rats by measuring epithelium thickness of seminiferous tubuli (MSTet) and epithelium thickness of ductus epididymis (MDEet). Rats were randomly divided into 3 groups: group I underwent unilateral epididymal ligation; group II underwent unilateral vasal ligation and group III received sham operations. MDEet on the ipsilateral side of the epididymal ligation group significantly decreased compared to the contralateral side and sham group. For the contralateral side of the ligated vas, MDEet significantly decreased compared to the ipsilateral side and sham group. MSTet was less on the side of the operation than the contra lateral side and the sham group after both surgical procedures. The obstruction point of the male genital tract affect sperm parameters for clinical extraction or aspiration procedures.     

States causing infertility in adulthood in children with undescended testis

A total of 1386 operations for undescended testis was made in 1250 boys. In 774 of them an apparently intact testis and epididymis were found. In 612, such epididymal developmental abnormalities were detected which exclude or do not make possible the passage of sperms from these organs to the deferent duct. It is believed to be plausible that the large number of cases with infertility is due, also in individuals with a unilateral cryptorchidism, to the abnormal fusion of the epididymis in both testes.     

Morphologic effects of orchiopexy or orchiectomy on the contralateral testis in experimental unilateral cryptorchidism

For evaluation of the effects of orchiopexy and orchiectomy on the contralateral descended testis, unilateral cryptorchidism was produced in 60 21-day-old mice by suturing of the left testis to the inner abdominal wall. A sham operation was performed on the left testis of 20 control mice (S). After creation of unilateral cryptorchidism, orchiopexy (P) or orchiectomy (O) was performed on the left testis at 2 (group I) and 10 (group II) weeks (ten mice each). All testes were removed for examination 2 weeks after orchiopexy or orchiectomy. In both groups the mean values of testicular weight, seminiferous tubular diameter, and tubular biopsy score of contralateral O testes were always statistically similar to the values of contralateral S testes (p greater than 0.01). The difference between TBS values of contralateral P and S testes was not significant in group I (p greater than 0.01), but it was significant in group II (p less than 0.01). The data from this murine experiment suggest that orchiectomy for unilateral cryptorchid testis is almost always helpful in improving contralateral morphology; however, orchiopexy can be helpful if it is not performed late in the period of maturation.     

Obstructive infertility: changes in the histology of different regions of the epididymis and morphology of spermatozoa

In the present study, the effects of prolonged obstruction in different regions of the human epididymis on its histology and on the spermatozoa retained at the site of obstruction were assessed. Men who were confirmed of having obstruction of the epididymis underwent vasoepididymostomy (VEA) for surgical correction of the obstruction. At the time of surgery, fluid from the epididymal tubule above the site of obstruction was aspirated and examined for sperm profile. Epididymal tissue, collected at the site of obstruction, was processed for assessment of histological changes and also used to identify the site of obstruction. Prolonged obstruction of the epididymis has caused degeneration of the epididymal epithelium, gradual decrease in the diameter of the tubule and tubular lumen and increase in the intertubular connective tissue. Sperm aspirated from the caput epididymal fluid showed sluggish pattern of motility only in one out of the six subjects, whereas spermatozoa collected from the cauda epididymal fluid showed rapid linear progressive motility in one of three subjects. A major percentage of spermatozoa in the aspirated fluid showed various types of morphological abnormalities, irrespective of the site of obstruction. These results are discussed in relation to the role of the epididymis in investing spermatozoa with motility and fertilizing capacity.     

Treatment of renal angiomyolipoma: pooled analysis of individual patient data

Epididymal anomalies and patent processus vaginalis are frequently found in boys with cryptorchidism or hydrocele. We conducted this study to evaluate the association between epididymal anomalies and testicular location or patent processus vaginalis in boys with undescended testis or hydrocele. Children undergoing surgery with undescended testis (group A, 136 boys and 162 testes) or communicating hydrocele (group B, 93 boys and 96 testes) were included. Testicular locations and epididymal anomalies were investigated prospectively. An anomalous epididymis was defined as anomalies of epididymal fusion that consisted of loss of continuity between the testis, the epididymis, and the long looping epididymis. The epididymis was considered normal when a normal, firm attachment between the testis, the caput, and the cauda epididymis was present. The mean ages of groups A and B were 24.6 ± 19.7 (range, 8–52 months) and 31.4 ± 20.6 months (range, 10–59 months). The incidence of epididymal anomalies was significantly higher in group A than that in group B (65.4 % vs. 13.5 %, P < 0.001). The incidence of epididymal anomalies in boys with undescended testis was significantly different according to testis location. Epididymal anomalies were observed in 100 %, 91.4 %, and 39.3 % of cases when the testis was located in the abdomen, inguinal canal, and distal to the external inguinal ring, respectively (P < 0.001). We conclude that epididymal anomalies were more frequent in boys with undescended testis than in boys with hydrocele, and that these anomalies were more frequent when undescended testis was at a higher level. These results suggest that testicular location is associated with epididymal anomalies rather than patent processus vaginalis.     

Management of cryptorchidism and gastroschisis

Background

Cryptorchidism is commonly associated with gastroschisis. Management of the undescended testes varies with regard to technique and timing of orchidopexy. To evaluate the appropriate timing of and procedure for orchidopexy in patients with gastroschisis, we reviewed our experience.

Methods

Male neonates admitted between January 1999 and September 2010 with gastroschisis were reviewed. This retrospective study was conducted after institutional review board approval. Testis location at birth was recorded, and outcomes for those with undescended testes were analyzed.

Results

Sixty-two males with gastroschisis were identified, and 24 had cryptorchidism (38.7%) affecting 31 testes. All babies had an initial watch-and-wait approach without any attempt at orchidopexy during gastroschisis closure. Those with extraabdominal testes at birth had the testicle repositioned in the abdomen before gastroschisis closure. Mean follow-up was 27.3 months. At follow-up, 54.8% of the testes relocated without intervention and 38.7% required orchidopexy. Laparoscopy was used in 5 patients to perform the orchidopexy. A total of 3 testes required orchiectomy secondary to atrophy, one of which had previously undergone an orchidopexy. Two of the orchiectomies were performed laparoscopically.

Conclusion

The watch-and-wait approach for cryptorchidism in gastroschisis is safe and appropriate, with a high rate of spontaneous migration during the first year of life and greater than 90% testes viable at follow-up. Laparoscopy is a safe and feasible option for management of undescended testes that remain intraabdominal at follow-up.     

L-肉碱在奥硝唑所致大鼠睾丸和附睾损伤中的保护作用

目的:探讨L-肉碱(LC)在奥硝唑(ORN)所致大鼠附睾和睾丸损伤中的的保护作用。方法:40只雄性SD大鼠(200～230g)随机均分为5组:①A组:给予0.5%的羧甲基纤维素钠(溶剂)灌胃;②B组:每天给予400mg/kgORN灌胃;③C组:每天给予800mg/kgORN灌胃;④D组:每天给予[ORN(400mg/kg)+LC(100mg/kg)]灌胃;⑤E组:每天给予[ORN(800mg/kg)+LC(100mg/kg)]灌胃。上述各组均连续灌胃20d,末次给药24h后,所有大鼠麻醉后处死,分别取睾丸、附睾,进行称重和HE染色,计算睾丸、附睾系数并观察睾丸和附睾病理组织学改变。结果:①与A组相比,B组睾丸、附睾系数明显降低(P<0.05);而C组睾丸、附睾系数为极显著性降低(P<0.01);D组与A组相比无差异,E组与A组相比有极显著性差异(P<0.01);②HE染色显示,与A组相比,B组睾丸生精小管内各级生精细胞排列基本整齐,部分生精小管管腔内有脱落的生精细胞,附睾管腔中精子数目下降,有时可见散在的生精细胞;C组大鼠睾丸生精小管管腔内均可见坏死脱落的生精细胞,附睾管腔中精子数目明显减少,且有较多的非精子细胞成分。D组睾丸生精小管无明显改变,附睾管腔中精子数目也未见明显下降;E组睾丸生精小管管腔内精子数目减少,可见坏死脱落的生精细胞,附睾腔中精子数目明显减少,并伴有较多的非精子细胞成分。结论:奥硝唑(ORN)可导致雄性大鼠附睾和睾丸病理组织学改变,LC对ORN引起大鼠附睾和睾丸损伤具有一定的保护作用。     

Congenital anomalies of the mesonephric duct and fertility

Agenesia of deferential duct and the others congenital malformations of mesonephronical duct are often encountering condition in andrological practice. This study presents the possibilities of reproductive medicine to restore the male fertility and concentrates on biological and clinical aspects of malformations of mesonephronic duct like factors for excretory male infertility. The investigations including 104 patients (mean age 30.25+/-1.91 years old) with congenital anomalies of mesonephronical duct with: Agenesia of mesonephronical derivates - case with unilateral agenesia of the deferent duct, kidney and left urether (n=1); Dysgenesia of the epididymis (n=5); Cysts of the epididymis (n=47); Agenesia of the deferential duct (n=48); Aplasia of the eja-culatorial duct (n=3). The following methods were used: open testicular biopsy by Vilar; objective findings in situ operation; bilateral epididymo - and deferentovesiculography; morphological specimens of the testicular and epididymal tissues; enzymohistochemical analysis of testicular specimens; the ejaculates and morphological analysis of spermatozoa were assessed for quality parameters by the standard protocol; enzymocytological research of spermatozoa in seminal fluid; biochemical analysis of seminal fluid fructose and citric acid concentrations; radioimmunoassay for measurements of blood FSH and testosterone concentration. RESULTS: Most often observed localization of the malformations of mesonephronic canal is bilateral at 54.81%. The testicular specimens proved preserved testicular architecture and spermatogenesis, and the epididymal slides showed dilatation of the epididymal tubules, which were overfilled with a lot of spermatozoa. The strongest expression of the enzymichistochemical NADH-TR reactions is in the Sertoli cells. We observed spermatozoa with disrup-ted configuration among which the abnormalities in sperm head and acrosome were predominated. The biochemical analysis of seminal fluid proves normal citric acid and low or lack of fructose concentration in seminal fluid. There were no breaches in endocrine regulation of the reproductive process. Patients with congenital anomalies of mesonephronic canal have preserving fertility in 31.73%. There are morpho-functional disorders of the testes, epididymis and seminal ducts in 68.27%. CONCLUSION: There are normal spermatogenesis but definite sterility. These results necessitate an application of plastic reconstructive operation for recovery of fertilizing ability of the patients, or their involvement in ICSI programme.